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Philadelphia (March 10) – Use of the illicit drug crystal methamphetamine is one of several factors that may be fueling increases in sexually transmitted diseases (STDs) among gay and bisexual men in the United States, according to new research presented at the 2004 National STD Prevention Conference. One day following the release of preliminary data from the Centers for Disease Control and Prevention (CDC) showing the third consecutive year of increases in syphilis cases in 2003*, findings presented today provide crucial insight into the factors behind increasing STD diagnoses among men who have sex with men (MSM).

Role of Crystal Methamphetamine in Spread of STDs

Three studies indicate that crystal methamphetamine (“crystal”) use is associated with high-risk behavior and infection with STDs, including HIV, among MSM in San Francisco. A CDC study of 388 MSM found that 16 percent used the drug the last time they had anal sex. Crystal users in that study were twice as likely as non-users to engage in unprotected receptive anal intercourse (Abstract 1034).

Researchers at the San Francisco Department of Public Health (SFDPH) found that MSM who used crystal and Viagra together were 6.1 times more likely to be diagnosed with syphilis than those who did not use either drug (Abstract 1429). In another study from SFDPH, researchers found that 17.4 percent of 1,263 MSM who attended the city’s public STD clinic had used crystal in the four weeks before their visit. Those who used the drug were more than twice as likely as non-users to be HIV infected, 4.1 times as likely to be diagnosed with syphilis, and 1.7 times as likely to test positive for gonorrhea (Abstract 1357).

“The increased threat of syphilis and other STDs among gay and bisexual men is being driven in part by a troubling combination of drug use and complacency,” said Dr. Ronald O. Valdiserri, deputy director of the HIV, STD and TB prevention programs at CDC, one of the conference’s sponsors. “Efforts to reduce the impact of STDs among gay and bisexual men must address these underlying factors.”

Connections Between HIV Infection and other STDs

Two studies presented this week show higher levels of STDs among MSM who are also infected with HIV compared to uninfected MSM, pointing to the need for prevention programs for people who are living with HIV infection. A study of MSM attending a community health center in Boston found that being infected with HIV was the single most significant predictor of receiving a syphilis diagnosis (Abstract 1220). In a second study, a CDC analysis of MSM attending STD clinics nationwide found that MSM with HIV were approximately twice as likely as HIV-uninfected MSM to test positive for urethral, anal or pharyngeal gonorrhea (Abstract 1128).

“High rates of HIV infection among men diagnosed with STDs underscore the importance of tailoring STD prevention efforts for HIV-infected gay and bisexual men,” said Dr. John Douglas, director of STD prevention programs at CDC. “People living with HIV need ongoing, focused prevention to maintain safe behaviors and to protect their health and that of their partners.”

Interim findings from an additional study, underway by researchers at Public Health – Seattle & King County, show that only 36 percent of 149 MSM studied were aware of the HIV status of their most recent anal sex partner before sex. Even after discussing HIV status, many participants disregarded positive disclosures by their partners, usually due to sexual desire or substance use. Some also took risks based on negative disclosure alone, without obtaining additional key information such as the last time their partner was tested (Abstract 1359).

Internet and Commercial Sex Venues Also Factors

Researchers at the Los Angeles County Department of Health Services found that many MSM who were diagnosed with syphilis met their sexual partners online or at commercial sex venues. In one study, 22 percent of 587 MSM diagnosed with early syphilis in Los Angeles had met one or more sexual partners on the Internet around the time that they were most likely infected. Two-thirds of study participants who met sex partners on the Internet were co-infected with HIV (Abstract 1441). Another study found that 28 percent of 658 MSM diagnosed with early syphilis in Los Angeles met one or more sexual partners in commercial sex venues, such as bathhouses and sex clubs. Those who reported meeting partners in these venues were also twice as likely to have HIV infection (Abstract 1440).

Despite the role of the Internet in facilitating risk behavior and STD transmission among MSM, new research shows that it can also be a useful tool in notifying sexual partners of people diagnosed with STDs. Researchers at the Minnesota Department of Health contacted 50 individuals who may have been exposed to STDs who could only be located by their email addresses or screen names. Sixty percent (30 out of 50 contacted) responded to the online notification – a higher percentage than expected (Abstract 1282). Similarly, 7 out of 8 sexual partners contacted electronically in a Chicago study responded and were successfully referred to appropriate health care (Abstract 1313).

In the face of increased syphilis rates among MSM, community-based prevention programs are showing promising results in several cities. In Houston, Texas, an awareness campaign tailored to MSM contributed to a 22 percent increase in the number of MSM who were tested for syphilis in the city over the course of a single year (Abstract 1410). In other research, the Chicago Department of Public Health reported that a syphilis awareness campaign in that city led to greater syphilis awareness and significantly increased the proportion of MSM who knew that syphilis facilitates HIV transmission (Abstract 1165).

About the Conference

The 2004 National STD Prevention Conference is the leading U.S. conference focusing on sexually transmitted diseases. The conference presents the latest data on national and local STD trends and highlights new STD prevention strategies, research and treatment options. Participants include more than 1,000 delegates from academic, public health, nongovernmental and policy organizations.

This year’s conference is sponsored by the Centers for Disease Control and Prevention (CDC), the American STD Association (ASTDA), the National Coalition of STD Directors (NCSD) and the American Social Health Association (ASHA).